Núria Argudo1, M Pilar Iskra2, Miguel Pera3, Juan J Sancho1, Luis Grande3, Manuel López-Cano4, José Antonio Pereira5. 1. Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Barcelona, España; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España. 2. Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Barcelona, España. 3. Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Barcelona, España; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España; Grupo de Investigación de Cáncer Colorrectal, Instituto Hospital del Mar de Investigaciones Médicas (IMIM) , Barcelona, España. 4. Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España; Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Barcelona, España. 5. Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universidad Pompeu Fabra, Barcelona, España. Electronic address: 86664@parcdesalutmar.cat.
Abstract
OBJECTIVE: Incisional hernia (IH) after colorectal surgery is highly prevalent. The objective of this study is to assess the utility of an algorithm to decide on mesh augmentation after a midline laparotomy for colorectal resection to prevent IH in high-risk patients. METHODS: A prospective study was conducted including all patients undergoing a midline laparotomy for colorectal resection between January 2011 and June 2014, after the implementation of a decision algorithm for prophylactic mesh augmentation in selected high-risk patients. Intention-to-treat analyses were conducted between patients in which the algorithm was correctly applied and those in which it was not. RESULTS: From the 235 patients analysed, the algorithm was followed in 166 patients, the resting 69 cases were used as a control group. From an initial adherence to the algorithm of 40% in the first semester, a 90.3% adherence was achieved in the seventh semester. The incidence of IH decreased as the adherence to the algorithm increased (from 28 to 0%) with a time-related correlation (R2=0.781). A statistically significant reduction in IH incidence was demonstrated in high-risk groups in which the algorithm was correctly applied (10,2 vs. 46,3%; p=0,0001; OR: 7,58;95%; CI: 3,8-15). Survival analysis showed that the differences remained constant during follow-up. CONCLUSION: The implementation of the algorithm reduces the incidence of IH in high-risk patients. The adherence to the algorithm also correlates with a decrease in the incidence of IH.
OBJECTIVE: Incisional hernia (IH) after colorectal surgery is highly prevalent. The objective of this study is to assess the utility of an algorithm to decide on mesh augmentation after a midline laparotomy for colorectal resection to prevent IH in high-risk patients. METHODS: A prospective study was conducted including all patients undergoing a midline laparotomy for colorectal resection between January 2011 and June 2014, after the implementation of a decision algorithm for prophylactic mesh augmentation in selected high-risk patients. Intention-to-treat analyses were conducted between patients in which the algorithm was correctly applied and those in which it was not. RESULTS: From the 235 patients analysed, the algorithm was followed in 166 patients, the resting 69 cases were used as a control group. From an initial adherence to the algorithm of 40% in the first semester, a 90.3% adherence was achieved in the seventh semester. The incidence of IH decreased as the adherence to the algorithm increased (from 28 to 0%) with a time-related correlation (R2=0.781). A statistically significant reduction in IH incidence was demonstrated in high-risk groups in which the algorithm was correctly applied (10,2 vs. 46,3%; p=0,0001; OR: 7,58;95%; CI: 3,8-15). Survival analysis showed that the differences remained constant during follow-up. CONCLUSION: The implementation of the algorithm reduces the incidence of IH in high-risk patients. The adherence to the algorithm also correlates with a decrease in the incidence of IH.
Authors: A Bravo-Salva; A M González-Castillo; F F Vela-Polanco; E Membrilla-Fernández; J Vila-Domenech; M Pera-Román; J J Sancho-Insenser; J A Pereira-Rodríguez Journal: World J Surg Date: 2020-03 Impact factor: 3.352
Authors: Núria Argudo; Miguel Pera; Manuel López-Cano; Lourdes Hernández; Juan José Sancho; Luis Grande; José Antonio Pereira Journal: Front Surg Date: 2018-02-16